Prior pain induces heightened motor responses during clustered care in preterm infants in the NICU
Prior pain induces heightened motor responses during clustered care in preterm infants in the NICU
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DOI：
10.1016/j.earlhumdev.2004.08.002
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发表时间：
2005-03-01
影响因子：
2.5
通讯作者：
Whitfield, MF
中科院分区：
文献类型：
--
作者：
Holsti, L;Grunau, RE;Whitfield, MF
背景资料：急性疼痛是新生儿重症监护病房（NICU）中早产儿的重要应激源，然而，急性疼痛对触觉处理集群过程中后续运动反应的影响知之甚少，目的：（1）比较胎龄32周的早产儿在休息期后的常规护理任务中的面部、身体和心率反应（RCC：换尿布、测量腹围和腋温、口腔护理）以及他们对采血后的护理反应（PCC）。(2)研究出生时GA如何影响RCC和PCC期间的应激模式和自我调节行为。研究设计：组内交叉设计对象：早产儿，N=54（出生时的平均GA为29.3 +/- 2.2周;平均出生体重为1257 +/- 423 g）在新生儿重症监护室（NICU）的32周GA时进行评估。新生儿发育护理和评估计划（NIDCAP（R））和新生儿面部编码系统（NFCS）从连续床边视频记录编码。平均心率（HR）的变化采用自定义生理软件计算。结果：所有婴儿的面部，身体和HR反应时，CC遵循痛苦的程序相比，当他们没有处理之前，CC婴儿出生在早期GA（< 30周）在RCC和PCC期间具有相同数量的压力线索，但在PCC期间抑制了自我调节行为。先前的疼痛诱导早产儿在随后的触觉程序中的生物行为反应性升高。此外，集群护理是特别紧张的婴儿出生在早期GA。(c)2004爱思唯尔爱尔兰有限公司保留所有权利。
Background: Acute pain is a significant stressor for preterm infants in neonatal intensive care units (NICU); however, little is known about the effects of acute pain on subsequent motor responses during clusters of tactile handling.Aims: (1) To compare facial, body and heart rate reactivity in preterm infants at 32 weeks gestational age (GA) during routine care-giving tasks following a rest period (RCC: diapering, measuring abdominal girth and axillary temperature, mouth care) with their responses to Clustered Care following blood collection (PCC). (2) To examine how GA at birth affects patterns of stress and setf-regulatory behaviors during RCC and PCC.Study Design: Within-group crossover design (random order).Subjects: Preterm infants, N=54 (mean GA at birth 29.3 +/- 2.2 weeks; mean birth weight 1257 +/- 423 g) were assessed at 32 weeks GA in the NICU.Outcome measures: The Newborn Developmental Care and Assessment Program (NIDCAP (R)) and Neonatal Facial Coding System (NFCS) were coded from continuous bedside video recordings. Changes in mean heart rate (HR) were computed using custom physiologic software.Results: All infants had heightened facial, body and HR responses when CC followed a painful procedure compared to when they had not been handled prior to CC infants born at earlier GA (< 30 weeks) had equal numbers of stress cues during RCC and PCC, but dampened self-regulatory behaviors during PCC.Conclusion: Prior pain induces heightened biobehavioral reactivity in preterm infants during subsequent tactile procedures. In addition, clustering care is particularly stressful for infants born at earlier GA. (c) 2004 Elsevier Ireland Ltd. All rights reserved.